Somatostatin in acute bleeding oesophageal varices. Pharmacology and rationale for use.

Somatostatin was originally isolated from the hypothalamus, but has subsequently been found throughout the whole gastrointestinal tract. It exerts an inhibitory effect upon numerous functions of the body, and, therefore, increasing attention has been focused on its potential as a therapeutic agent with cytoprotective properties and a potent inhibitory action on a wide variety of functions in endocrine diseases, cancer and gastrointestinal haemorrhage, including bleeding from oesophageal varices. As somatostatin has a very short plasma half-life and requires administration by continuous infusion to maintain therapeutic levels, stable long-acting analogues have been developed. The analogue octreotide has been shown to have a plasma half-life of 113 minutes and to produce a profound selective inhibition of growth hormone. Hepatic excretion of octreotide has been estimated to be between 30 and 40% in healthy volunteers; no data are available in cirrhotic patients. A review of published data assessing systemic and hepatic haemodynamics in animals and humans over varying dosage regimens of somatostatin and octreotide reveals that cardiac output, arterial pressure and peripheral resistance are modified more in animals than in humans. Hepatic haemodynamics are significantly altered in animals as well as in humans in most of the studies. Circumstantial evidence is provided indicating that the mechanisms of action of somatostatin and octreotide in the therapy of bleeding oesophageal varices are mainly mediated by a splanchnic vasoconstrictive effect. Furthermore, gastric acid suppression and potential enhancement of platelet aggregation may contribute to the beneficial outcome after treatment of oesophageal varices with somatostatin.

[Selective induction of tumors in Wistar rats with loop colostomy after administration of methyl-(acetoxymethyl)-nitrosamine (MAOMN) (author's transl)]. / Selektive Erzeugung von Tumoren an Wistar-Ratten an einem doppelläufigen Anus praeter nach Gabe von Methyl-(acetoxy-methyl)-Nitrosamin (MAOMN).

A single dose of 7 mg/kg methyl-(acetoxymethyl)-nitrosamine in Wistar rats with double loop colostomy induced adenomas, papillomas, and adenocarcinomas at the site of colostomy in 83% of the treated animals. The mean induction time was 320 days. The pronounced local effect as well as the high tumor yield are discussed in regard to the evident high epithelial sensitivity at the colostomy site.

[Primary open therapy of acute necrotizing pancreatitis by the "open abdomen"]. / Primär offene Therapie der akuten nekrotisierenden Pankreatitis durch das "offene Abdomem".

There is no agreement about a conservative surgical strategy in the therapy of acute necrotizing pancreatitis yet. This report describes our experience with "open packing" laparostomy. This procedure is only performed when renal and pulmonary insufficiency is proceeding, despite optimal conservative treatment. Since 1986 15 patients were treated in this manner. Three compartments are established: an upper compartment (stomach, liver, spleen--covered by the omentum majus, which is dissected from the colon transversum); a lower compartment (small bowel--covered by the left colon) and the mid compartment that permanently opens the bursa omentalis and the left retrocolic space. Initially a careful necrosectomy is performed, followed by a tamponade. At the intensive care unit changing of the tamponade and lavage of the bursa omentalis was done every day. So far two patients have died pursuing this therapeutic regimen.

The influence of autonomous nervous activity on total and regional gastric blood flow.

Using 8 mu radioactive microspheres total and regional gastric blood flow were measured in dogs under electrical splanchnic stimulation (SS), following splanchnicectomy (SE), under electrical stimulation of the vagal truncs (VS) and following truncal vagotomy (VE). The values were compared to controls and were taken while cardiac output (CO) and mean aortic pressure ( AOBP ) were registered. Total GBF was 16 +/- 4 ml/100g/min. in 8 animals. Regional flows were highest in the mucosa of corpus and fundus (35 +/- 7 and 27 +/- 6 ml/100g/min.) and lowest in the seromuscularis (4 +/- 1 ml/100g/min.) SS decreased total GBF to 7 +/- 2 ml/100g/min. and this was due to a most dramatic fall in corpus and fundus mucosal flow by 75%. In contrast SE increased total GBF to 30 +/- 11 and regional corpus mucosal flow achieved 85 +/- 24 ml/100g/min. Blood flow changes under VS were similar to those following SE but were less elevated. In the same manner flow reduction following VE was similar to the changes seen after SS but in average less profound. CO and AOBP increased during SS (less than 30% of control) but were almost the same for SE, VS and VE.

[Multiple synchronous small intestine carcinomas. A rare case observation]. / Multiple synchrome Dünndarmkarzinome. Eine seltene Fallbeobachtung.

We report on the extremely rare finding of a multiple synchronous, partly free perforated carcinoma of the small bowel. The histopathological diagnosis was a small-cell carcinoma of the small bowel. Malignant lymphoma, neuroendocrine or neuroendothelial malignancies were excluded immunohistochemically. In light of the intraoperative finding and the postoperative diagnostics, we are of the opinion that it is a primary multiple synchronous carcinoma of the small bowel.

[A pneumatic colostomy closure]. / Ein pneumatischer Anus-Praeter-Verschluss.

An atraumatic, pneumatic occlusive colostomy appliance has been described which in animal experiments was well tolerated and was effective in preventing leakage. It is hoped that this may improve the unsatisfactory aspects of management in patients using conventional colostomy appliances.

[The common channel syndrome in adults]. / Das Common-Channel-Syndrom beim Erwachsenen.

Congenital abnormalities of the distal bile and pancreatic duct occur predominantly as a long common channel. A common channel of more than 15 mm is considered abnormal, since the length allows a reflux of pancreatic secretion into the bile duct and vice versa. The very rare occurrence of a long common channel syndrome in adults has been observed in two female patients (24 and 58 years old). Both presented cholangitis and/or pancreatitis. Diagnosis was established by ERCP. The definitive therapy in both cases was hepatico-jejunal anastomosis which improved symptoms in both patients. Endoscopic sphincterotomy is unsatisfactory since it does not cut the entire common channel. The rare etiology of a long common channel in patients with cholangitis and pancreatitis is safely verified by ERCP and safely cured by surgical intervention.

[Experimental contribution to the etiology of colorectal carcinomas in the rat. Surgical technique and chronic administration of 1,2-dimethylhydrazine (author's transl)]. / Atiologische Studie zur Pathogenese experimenteller colorectaler Carcinome der Ratte anhand 3 unterschiedlicher Operationsverfahren und chronischer Gabe von 1,2-Dimethylhydracin.

Report on three different operative methods on the colon and rectum as basis for studies of the pathogenesis of colorectal cancer. Resection and colostomy predispose to cancer growth at the anastomosis or colostomy after application of 1,2 dimethylhydrazine.

[The effect of antacids on stress-induced lesions of the gastric mucosa in the piglet (author's transl)]. / Uber der Einfluss von Antazida auf stressinduzierte Magenschleimhautläsionen beim Ferkel

After administration of antacids, gastric stress lesions due to hemorrhagic shock appear in the pig stomach quicker and more markedly than in animals which have been similarly treated with an indifferent substance or not at all. However, once treated, the administration of antacids seems to favor the healing of mucosal lesions after the end of the stress. At the same time it was observed that after administration of antacids in hemorrhagic shock, the serum gastrin level rises and does not remain constant, as in the control group. An attempt is made to explain the favorable effect of antacids on the genesis of hemorrhagic stress lesions in the pig's stomach through this observation.

[Lose-dose treatment with vitamin A in prevention of stress ulcer in swine]. / Niedrigdosierte Vitamin A-Behandlung zur Stressulcusprophylaxe beim Schwein.

Hemorrhagic shock in 8 piglets (mean AoBP 40 mm Hg for 3 h) was followed by severe stress-induced gastric mucosal lesions (Gr-I). When vitamin A was administered simultaneously (50,000 IE/kg = Gr. II, n = 6 and 5,000 IE/kg = Gr. III, n = 7) during the procedure, no stress lesions were observed. The study shows that the simultaneous application of vitamin A during hemorrhagic shock, in a reasonable clinical dosage, protects the gastric mucosa against stress-induced lesions.

Elimination of porcine heptadecapeptide gastrin (G17) and human leu big gastrin (G34) by the perfused pig liver.

In order to study some of the molecular events during the hepatic passage of gastrin, we perfused sulfated natural porcine gastrin (G17 II) through isolated pig livers. The disappearance half time of G17 II was about 20-30 min when the starting gastrin concentrations were greater than 100 pM; lower concentrations were reduced with half times of 40-100 min. Synthetic human leu-32 (G34) was not eliminated. The use of region-specific antibodies to gastrin indicated that degradation was more effective at the N-terminus of gastrin. Whereas Sephadex chromatography revealed no change of the molecular size, SDS-polyacrylamide gel electrophoresis showed the presence of smaller immunoreactive fragments of gastrin in addition to immunoreactive fragments of gastrin of the heptadecapeptide size. These findings indicate that the isolated porcine liver degrades porcine G17 to smaller fragments.